Admission | K-PRAIZ MONTESSORI ACADEMY GALADIMAWA, ABUJA
HOUSE 1 BLOCK NG2 KNOWLEDGE COURT ESTATE, GALADIMAWA

REGISTRATION FORM

CHILD INFORMATION

Please complete one for each child requiring admission

Date of Birth


PARENT/GUARDIAN INFORMATION

Name of Parent/Guardian

EMERGENCY CONTACT

HEALTH RECORD


Has he/she suffered from any of the ILLNESS in the past? Please tick and include dates.

Please kindly select the VACCINATIONS already given to the child with dates.

Please tick below if your child/ward suffers from the following ailments:

Has the child been given any other vaccination apart from the ones stated above? Yes/NO. If yes, please state type:

Has the child ever undergone any surgical operation? If yes, state year, type of operation and attach surgical report:



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